Provider First Line Business Practice Location Address:
58133 29 PALMS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-369-4615
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2006